J Stroke.  2022 May;24(2):245-255. 10.5853/jos.2022.01095.

Etiology-Related Outcome of Endovascular Therapy in Posterior Circulation Stroke Compared to Anterior Circulation Stroke

Affiliations
  • 1Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
  • 2Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 3Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeugbu, Korea
  • 4Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Background and Purpose
We investigated the impact of stroke etiology on the endovascular treatment (EVT) procedure and clinical outcome of posterior circulation stroke (PCS) patients with EVT compared to anterior circulation stroke (ACS) patients.
Methods
We retrospectively analyzed ischemic stroke patients who underwent EVT between January 2012 and December 2020. Enrolled ACS and PCS patients were compared according to etiologies (intracranial arterial steno-occlusion [ICAS-O], artery-to-artery embolic occlusion [AT-O], and cardioembolic occlusion [CA-O]). EVT procedure and favorable clinical outcomes at 3 months (modified Rankin Scale 0–2) were compared between the ACS and PCS groups for each etiology.
Results
We included 419 patients (ACS, 346; PCS, 73) including 88 ICAS-O (ACS, 67; PCS, 21), 66 AT-O (ACS, 50; PCS, 16), and 265 CA-O (ACS, 229; PCS, 36) patients in the study. The onset-to-recanalization time was longer in the PCS group than in the ACS group (median 628.0 minutes vs. 421.0 minutes, P=0.01). In CA-O patients, the door-to-puncture time was longer, whereas the puncture-to-recanalization time was shorter in the PCS group than in the ACS group. The proportions of successful recanalization and favorable clinical outcomes were similar between the ACS and PCS groups for all three etiologies. Low baseline National Institutes of Health Stroke Scale (NIHSS) scores and absence of intracerebral hemorrhage at follow-up imaging were associated with favorable clinical outcomes in both groups, whereas successful recanalization (odds ratio, 11.74; 95% confidence interval, 2.60 to 52.94; P=0.001) was only associated in the ACS group.
Conclusions
The proportions of successful recanalization and favorable clinical outcomes were similar among all three etiologies between PCS and ACS patients who underwent EVT. Initial baseline NIHSS score and absence of hemorrhagic transformation were related to favorable outcomes in the PCS and ACS groups, whereas successful recanalization was related to favorable outcomes only in the ACS group.

Keyword

Ischemic stroke; Endovascular treatment; Etiology; Brain infarction

Figure

  • Figure 1. Flowchart of the patient selection process. ACS, anterior circulation stroke; PCS, posterior circulation stroke; ICAS, intracranial arterial stenosis; AT, artery-to-artery embolism; CA, cardioembolism; mRS, modified Rankin Scale; ICAS-O, intracranial arterial steno-occlusion; AT-O, artery-to-artery embolic occlusion; CA-O, cardioembolic occlusion.

  • Figure 2. Score on the modified Rankin Scale (mRS) at 3 months in (A) intracranial arterial steno-occlusion, (B) artery-to-artery embolism, and (C) cardioembolic occlusion patients between anterior circulation stroke (ACS) and posterior circulation stroke (PCS) groups. Numbers in a bar represent the number of patients.


Cited by  3 articles

Resurrection of Endovascular Thrombectomy for Posterior Circulation Stroke
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J Stroke. 2022;24(2):177-178.    doi: 10.5853/jos.2022.01620.

Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy
Seong-Joon Lee, Ji Man Hong, Jong S. Kim, Jin Soo Lee
J Stroke. 2022;24(2):207-223.    doi: 10.5853/jos.2022.00941.

A Review of Endovascular Treatment for Posterior Circulation Strokes
Sung Hyun Baik, Jun Yup Kim, Cheolkyu Jung
Neurointervention. 2023;18(2):90-106.    doi: 10.5469/neuroint.2023.00213.


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